N.J. Admin. Code § 10:166-1.2 - Definitions

"Advanced practice nurse" means "advanced practice nurse" pursuant to N.J.A.C. 8:43J-1.2.

"Asthma Guidelines" means the Expert Panel Report 3: Guidelines for the Diagnosis and Management of Asthma, Full Report 2007 of the National Heart, Lung, and Blood Institute of the National Institutes of Health, US Department of Health and Human Services, 2007 edition, incorporated herein by reference, as amended and supplemented, available at http://www.nhlbi.nih.gov/guidelines/asthma/asthgdln.htm.

"Average daily census" means the total units of service billed by a PMDC facility per calendar quarter divided by the total number of days during the same calendar quarter in which a PMDC facility was open for operation.

"Business day" means any day other than a Saturday or a Sunday, and any day other than a day designated as a holiday by the Federal government or the State of New Jersey.

"Calendar quarter" means a period of three consecutive months within a calendar year, beginning on January 1 and ending on March 31; beginning on April 1 and ending on June 30; beginning on July 1 and ending on September 30; or beginning on October 1 and ending on December 31.

"Child" means an individual aged birth through the last day prior to his or her sixth birthday.

"Class III medical device" means a medical device that the Food and Drug Administration has categorized as "class III" pursuant to 21 CFR 860.3.

"CMS" means the Centers for Medicare and Medicaid Services, a United States Federal agency within the Department of Health and Human Services, which administers Medicare, Medicaid and the State Children's Health Insurance Program.

"Cost report" means a document that contains PMDC facility information, such as facility characteristics, utilization data, cost and charges by cost center (in total and for Medicaid) and financial statement data prepared in accordance with N.J.A.C. 10:166-6.1.

"Department" means the New Jersey Department of Human Services.

"Device" means a device as that term is defined at Section 201(h) of the Federal Food, Drug and Cosmetic Act, 21 U.S.C. § 321(h).

"Division" means the Office of Community Choice Options in the Division of Aging Services of the Department, for which the contact information is as follows: Office of Community Choice Options, Division of Aging Services, NJ Department of Human Services, PO Box 807, Trenton, NJ 08625-0807, telefacsimile: (609) 984-3897.

"Facility" means a pediatric medical day care facility.

"Family" means individuals who are related by blood, marriage, civil union, domestic partnership or a legal process.

"Financial statement" means a formal statement of the financial status and net worth of a PMDC facility, setting forth and classifying assets, liabilities, revenue, expenses, sources and uses of funds, statement of changes in fund balance or net worth and notes as of a specified date prepared in accordance with N.J.A.C. 10:166-6.2.

"Fiscal agent" means an entity that processes and adjudicates provider claims on behalf of programs administered in whole or part pursuant to N.J.A.C. 10:49.

"Fiscal year" means the New Jersey State government's accounting year, which begins July 1 and ends June 30.

"Functional assessment" means an evaluation of a Medicaid beneficiary's health status performed by professional staff designated by the Department in accordance with N.J.A.C. 10:166-3.1

"Inflation adjustment factor" means a figure used to adjust for inflation between the establishment date of the base reimbursement rate and the prospective rate period.

"Initial plan of care" means an "initial plan of care" pursuant to N.J.A.C. 8:43J-1.2.

"Interdisciplinary plan of care" means an "interdisciplinary plan of care" pursuant to N.J.A.C. 8:43J-1.2.

"Interdisciplinary team" means "interdisciplinary team" pursuant to N.J.A.C. 8:43J.

"Licensed nursing staff member" means a registered professional nurse and/or a licensed practical nurse under the employ of a facility.

"Licensed practical nurse" or "LPN" means a "'licensed practical nurse' or 'LPN'" pursuant to N.J.A.C. 8:43J-1.2.

"Medicaid" means medical assistance provided under a State plan approved under Title XIX of the Social Security Act or otherwise authorized under Title XIX or Title XXI of the Social Security Act, including Medicaid Waiver programs authorized under sections 1115 and/or 1915 of the Social Security Act.

"Medicaid Administration Manual" means N.J.A.C. 10:49.

"Medicaid beneficiary" means a child whom the county board of social services has determined to be financially eligible to participate in Medicaid.

"Medical director" means "medical director" pursuant to N.J.A.C. 8:43J-1.2.

"Medically complex child" means a child who exhibits a severity of illness that requires ongoing skilled nursing intervention.

"Medication administration" means "medication administration" pursuant to N.J.A.C. 8:43J-1.2.

"Neonatal intensive care unit" or "NICU" means "neonatal intensive care unit" pursuant to N.J.A.C. 8:43J-1.2.

"Nursing director" means a "nursing director" pursuant to N.J.A.C. 8:43J-7.

"Ongoing" means 24-hours per day, seven days per week.

"Parent" means a "parent" pursuant to N.J.A.C. 8:43J-1.2.

"Pediatric medical day care" or "PMDC" means a health care service designed to meet the medical, developmental, educational, nutritional and psycho-social needs of medically complex and/or technology-dependent children whose medical condition requires treatment and services beyond the scope provided to children with special health care needs by day care centers or preschool programs.

"Pediatric medical day care facility" or "PMDC facility" means a facility licensed by the Department in accordance with the Standards for Licensure of Pediatric Medical Day Care Facilities, N.J.A.C. 8:43J and that possesses a valid and current Medicaid provider agreement with the Department.

"Physician" means "physician" pursuant to N.J.A.C. 8:43J-1.2.

"PMDC beneficiary" means a child who is a Medicaid beneficiary and meets clinical eligibility criteria for PMDC pursuant to N.J.A.C. 10:166-3.1 and has obtained prior authorization to receive PMDC services pursuant to N.J.A.C. 10:166-3.4.

"Prescribed therapies" mean PMDC facility services as described at N.J.A.C. 10:166-5.1.

"Primary health care provider" means "primary health care provider" pursuant to N.J.A.C. 8:43J-1.2.

"Prior authorization" means the process set forth at N.J.A.C. 10:166-3by which professional staff designated by the Department determine whether a Medicaid beneficiary is clinically eligible to receive PMDC services.

"Private-duty nursing" means individual and continuous nursing care, provided by licensed nursing staff pursuant to N.J.A.C. 10:60-5.

"Registered professional nurse" or "RN" means "'registered professional nurse' or 'R.N.'" pursuant to N.J.A.C. 8:43J-1.2.

"Skilled nursing intervention" means care that requires the knowledge and experience of licensed nursing staff or a specially trained primary caregiver able to meet the specific needs of the child in the child's home.

"Technology-dependent child" means a child who requires a specific class III medical device to compensate for the loss of a vital body function to avert death or further disability and ongoing skilled nursing intervention in the use of the device.

"Transportation services" means the conveying of PMDC participants who require transportation between a PMDC facility and the child's home, either directly or through contractual arrangements, in accordance with N.J.A.C. 8:43J-16.

"Unit of service" means a minimum of six consecutive hours of service provided daily to a PMDC beneficiary at a PMDC facility.

"Week" means seven calendar days, starting on Sunday and continuing through Saturday.

Notes

N.J. Admin. Code § 10:166-1.2
Amended by R.2017 d.090, effective May 15, 2017.
See: 48 N.J.R. 2751(a), 49 N.J.R. 1227(a).
In definition "Division", deleted "and Community" following the first occurrence of "Aging".

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